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Monday, 3 October 2016

On Tim Noakes and Bullsh*t

A long read but well worth your time. Welcome to the fantasy world of the average dietitian.

On Tim Noakes and Bullsh*t by Gary Watson

A while ago I decided to try the ‘Tim Noakes diet’. My mother died of Type-2 diabetes complications so you could say I was somewhat interested in nutritional cause and effect. I lost 6kg in 6 weeks. Felt great. Great until one of my wife’s friends came round and remarked how much better I was looking. Smugly I replied “Tim Noakes’ diet”. “What? No! I’m a registered dietitian, so don’t talk to me about Tim Noakes” she retorted. “Why not?” I worried asked, “I’ve lost 6 kilos since I cut out the carbs”. “Yes, of course you’ll lose weight”, she replied irritatedly, “Your body goes into ketoacidosis! And besides, I have read all of Tim Noakes’ clinical studies on the matter, and they are all very flaky and vague”. Wow…ketoaci-whats-it-called doesn’t sound very healthy.

Now I was really interested. Though not too worried because a Master’s degree in Science does teach one where to go looking for the kind of evidence health professionals are supposed to base their advice on. To be clear, this qualifies me no more than you in almost every aspect in life; except perhaps it has taught me to spot bullsh*t dressed up in fancy-pants science jargon better than most. I am an unapologetic empiricist; if there’s no evidence, then its bullsh*t. So when someone tells me a scientist of Tim Noakes’ ilk has presented an idea based on ‘flaky and vague’ evidence, I can’t resist rubbernecking that potential academic car wreck. I mean seeing someone like Tim Noakes stuff things up is too good an opportunity to miss; schadenfreude is an undeniably intoxicating primal urge.

And so begun my journey into a land of bullsh*t and fantasy that is ‘established’ human nutrition theory. I can confidently say I do not know of any field of human endeavor in which so much bullsh*t, unsubstantiated hypotheses and complete nonsense has been presented and accepted as science and as conventional wisdom. Pick any subject from saturated fat, to fish-oil supplements, antioxidants supplementation, to the benefits of fibre in lowering cancer and you get – drum roll – nothing! Nothing but really bad science, wishful thinking and the wilful misrepresentation by an industry that pretends it knows what it is doing.

I quickly discovered that often, not always but often, when someone started a sentence with “I’m a registered dietician….” bullsh*t invariably ensued. Now before go any further, let’s understand why the term “registered dietician” is so important, and then I’ll define what I mean by bullsh*t in this context. Firstly, who the hell am I to say that a person required by law to be registered with the Health Professions Council, with a bachelor’s degree is a bullsh*tter? Perhaps it could be that precisely because they are required to be registered as health professionals, and because they have spent money getting university educated in order to have some sort of ascribed social authority conferred on them by the title “registered dietitian”, that they are duty-bound to provide evidence-based advice to the public. This is an obligation, not an ‘optional extra’. Evidence-based interventions are the basis of what it means to be a health professional, otherwise why bother going to all those lengths to get qualified and registered? Yet from the research I have conducted, reading 1000’s of pages of academic medical journals, articles and textbooks, speaking to at least a dozen “registered dietitians”, scouring the comments sections of several online nutrition forums frequented by “registered dietitians” - I am left completely convinced that many, not all but many, of these ‘health professionals’ don’t seem to appreciate this fundamental obligation. Time after time, all I get when I asked for evidence is subjective anecdote after subjective anecdote, and very little proper evidence. Just vague statements like “low carb eating is bad for you, clinical trials have proven this”; with an absolute inability to reference any of the clinical trials of they so confidently refer to. That’s not only bogus science, its damn unethical.

I can’t take my child to the doctor and be told they are seriously ill, but that maybe if we close our eyes, sing kumbaya, and believe in the power of prayer they’ll get better. My child might get better but like you, I’d like an evidence-based intervention please. What nutrition ‘experts’ fails to realize is that when they dress their personal beliefs up as scientific evidence-based fact, they undermine the quality of care they provide their clients.

But before we tar all “registered dietitians” with the same brush, and I don’t I promise, let me define bullsh*t and the three types of “registered dietitians” I have come across. Based on Professor Harry Frankfurt (1986) essay “On Bullshit” we get diet truth tellers, we get diet liars and we get diet bullsh*tters. Truth tellers convey the facts, with measured caution. Liars know the facts, but willfully mislead. But bullshitters just make up any story to impress the people that pay money or take the time to listen to them. (See Ben Goldacre’s book – Bad Science).

In order to illustrate my point, I will use the comments used by some people that presented themselves as “registered dietitians” when they responded to Tim Noakes’ original Health 24 post on low carb eating. The truth tellers said something like, “We don’t really know if low-carb diets are good for you long-term, but the short-term evidence looks promising. However I advise you to research this for yourself and exercise caution”. The liar will say “I am a dietitian and a scientist, and there isn’t a single shred of scientific evidence to support what Tim Noakes is saying”. That’s a lie. Firstly that contributor is not a scientist. If they were they would not publicly describe themselves as one, make such a declarative statement, then and wilfully ignore the plenty of high-quality, transparent, peer-reviewed, independently-funded scientific trials and experiments (on humans not rats) in the most respected scientific journals across the world supporting Tim Noakes’ position (see links below). Which brings us to the bullsh*tter – the ones that say completely irrelevant things like “Noakes is not credible because he uses a Victorian-era example” before going on to say “the Dukan and Atkins Diet have been totally debunked as extremely risky in multiple clinical trials” without a single reference to these “multiple clinical trials”. Please, Tonto…tell me where I can read the multiple clinical trials you refer to for myself. I have looked everywhere for them and couldn’t find a single reputable study to support your very specific, very declarative assertion. You have basically called Tim Noakes a liar in public without providing us with the courtesy of a single reference. But from where I am sitting, it is you that has taken a lie, dressed it up with sciencey-sounding words and deliberately tried to present yourself as someone more knowledgeable than Tim Noakes. That’s scientific fraud and the only way out for you is to produce the actual evidence to which you refer. It appears you not only present a complete misunderstanding of the scientific method, you also lack the basic ethics and courtesy of an academic or a scientist. The truth isn’t whether low-carb eating is good or bad for you. I suspect the truth is you are nothing but a bullsh*tter. And no this is not ne of those situations where you can respond with some inanity like “Well, I’m entitled to my opinion” either. You disparaged a respected scientist in public, so put up or shut up.

By now you will have realized this article is not really about low-carb eating. I know enough about nutrition to know that when someone says they know what they are talking about, they almost certainly don’t. A real scientist will admit that, so my beef is not with “registered dietitians”. Well not the honest ones that acknowledge the limits of their wisdom and base their recommendations on real evidence. I have a problem with the ones that so obviously dress up unsubstantiated nutritional bullsh*t as science and abuse the professional title bestowed on them. I couldn’t give a fig if you eat low-carb, low-fat or gorge yourself on pies and Coke for the rest of your life; just don’t prostitute science to support your nonsense.

Another example is the “saturated fat causes heart disease” hypothesis. For every conclusive clinical trial you can produce to support this hypothesis, I’ll produce one that refutes that causality – because as any scientist will tell you, causality in humans is very difficult to establish with any degree of certainty. Smoking and lung cancer – yes; fat and heart disease – nothing yet, maybe nothing at all. What isn’t difficult to say is that the link between saturated fat and heart disease has not been substantiated. Yet find a mainstream nutritionist that doesn’t warn against the dangers of saturated fat….. It’s just a personal belief dressed up the in a suit of ‘registered’ respectability. It’s not real science.

Perhaps you’re a dietitian and you are reading this aghast. How dare some punk like me disparage my registered dietitian colleagues like this! If you feel the urge to jump to the defence of everyone that describe themselves as “registered dietitians” consider how many of those people you would allow to feed your children. Consider too that a recent poll of British hospital doctors found that 80% would NOT want some of their colleagues to treat their friends and family (see http://www.independent.co.uk/life-style/health-and-families/health-news/majority-of-doctors-think-some-colleagues-unfit-for-job-9050260.html). So yes, you get three kinds of dietitians and being “registered” doesn’t stop the bullsh*t. Clearly.

So what qualifies me to speak on the bullsh*tness of dietary recommendations? Nothing more than an understanding of the scientific approach and a hopefully less of a ‘confirmatory bias’ than the people in the industry. Most of us tend to focus on evidence that supports our preconceived ideas and beliefs, while ignoring the inconvenient findings that suggest we may be wrong. I find this no more common than in the field of human nutrition, with the exception of maybe parenting and human resource management, but that’s a story for another day. Worry not! The history of nutritional theory is absolutely beset with confirmatory bias. Me? I know nothing of nutrition, but I know how to read real scientific academic medical journals. I know which libraries to find them in, I have access to the Cochrane Collaboration (if you don’t know what that is and you give nutritional advice you only prove my case). I can also spot poor experimental and clinical trial design and methodologically flawed studies – and I know that the evidence for cause and effect in humans is incredibly tenuous at best. Furthermore, real science and real scientists are transparent and answer the question when asked, they don’t obfuscate the issue. I also know credible research sources do not include Runner’s World magazine (a purveyor of nutritional bullsh*t if ever there was) or some esoteric Earth Life Natural Living Organic mumbo jumbo; just as much as they do not include studies conducted by the Atkins Nutritional Institute into the efficacy of the Atkins Diet Revolution Version 4.2.3 either. So I sincerely hope you doubt my credentials and take nothing I say at face value. All the same I sincerely hope you decide to check out some of the published, peer-reviewed journal articles in the link below that provide a more sober and realistic assessment of the potential benefits and risks of low-carb eating. Just Google “Medical research into low carb eating”. Pleaty of resources will be available – then look for peer-reviewed, non-industry funded articles out of medical journals – you usually need only read the abstract to get the jist. Then decide for yourself – you will find some research in favour, and that is cautionary. You won’t find any that say low-carb eating is “extremely risky and dangerous” as many registered dietitian will have you believe – that’s just bullsh*t.

And for those that may not want to read, but want a lesson in nutritional science anyway, check out Stanford University School of Medicine’s Dr. Christopher Gardner present his findings of various low-fat, high-carb, low-calorie and low-carb diets. All I can promise you is that Professor Gardner knows more about human nutrition than your “registered dietitian” does. Just Google ‘Gardner Diet Study’ and see how a devout vegetarian overcomes any potential confirmatory bias through robust, transparent experimental design - hint the Atkins Diet wins by a large margin. Why would one of the world’s most respected nutritional researchers at one of the preeminent research universities, a vegetarian no less, not be warning you of the dangers of low-carb eating? Perhaps it’s because he lets the science do the talking. Maybe it’s just that he’s not a bullsh*tter.

If you are still not convinced, check out Harvard University’s School of Public Health DIRECT study of 82,802 women; and why low carb eating comes up trumps. So where’s the complete lack of scientific evidence that our “dietitian and scientist” friend was referring to? Oh of course, she was lying.

So how do we know when we are being bullsh*tted? When a self-appointed nutrition ‘expert’ says “a calorie is just a calorie”. Or when they say “Calories in must be less than calories out”. Or they use sciencey-words like “the laws of thermodynamics and energy conservation” . Those are actual myths that have been actually debunked. My personal favorite, sh*t-eating sentence is “one gram of carb contains 4 calories while a gram of fat contains 9 calories”. This may be true, but it is totally irrelevant in human metabolism. It has nothing to do with making you fat.

So when someone says “low-carb diets are just fad-diets” – even the American Heart Association has changed its initial position in the face of emerging evidence. Or if a nutritionist says “low carb diets are dangerous” then you really know they a merely surmising, and not quoting anything resembling evidence. Another favorite of mine is “children need a carb-rich diet”. Bullsh*t, if only because the human species has consumed a low-carb, high-fat diet for 100,000 years; yet the greatest change to our diet in our history as a species has been the introduction of a carbohydrate orgy in the last 100 years! Eat whole-grains, or low GI some say! Why? Our growing children did just fine on low to moderate carb consumption for 99.9% of the existence of the human race, and they’ll do just fine doing the same for the next 99.9% too.

I am NOT advocating any eating plan here. I am NOT a nutritionist or dietitian – even though I argue that often that does not qualify someone to advocate an eating plan either. In my opinion, no one should be allowed to give nutritional advice without reading at least two important books. You can decide what you want to do with the information, but if you want to be credible in nutrition you at least be informed of all sides of the debate – one is The Diet Delusion by Gary Taubes; the other is Bad Science by Ben Goldacre. I guarantee you; both will change way you think about diet. If you are able to set your confirmatory bias aside, you’ll learn that that everyone is different, and that everyone has different dietary needs. This is exactly what Tim Noakes says. Noakes never said low-fat, high-carb diets are extremely dangerous; it’s the registered dietitians that responded to him by saying low-carb eating is – and that’s simply not true. There are plenty of resources at your disposal for you to do your own research and form your own opinion.

So I hope you never take anything I say – on this matter or another – at face value. If you tell me you don’t believe a word I’ve written, I’ll take that as a compliment. Just go do your own research before you pass judgment. Always ask for evidence – proper evidence, not some trash out of a magazine that uses words like “Studies show……” then doesn’t reference the study. Remember the guidelines of some Associations are usually beset with legacy issues and potential legal liability if they change their recommendations too quickly. My mother was advised to eat a low-fat diet to manage her diabetes, in line with the diabetes association recommendations of the day, and the emerging evidence appear to suggest they could not have been more wrong! Now that makes me f**king angry and potential litigious.

As for the ketoacidosis that several ‘registered dietitians’ told me I would experience on the Tim Noakes eating plan, I think they that may have meant ketosis. Any health professional that doesn’t know the difference between a life-threatening diabetic condition and a common bodily occurrence (we all experience a little ketosis before we eat breakfast in the morning – skip breakfast tomorrow and pee on a Ketostick if you don’t believe me) is either a liar or a bullsh*tter. They should not be starting sentences in public with “I’m a registered dietitian….” because they are doing their profession and their reputations a disservice.

In closing, no doubt the trolls and self-appointed nutritional experts will get stuck in to me, and no doubt Tim Noakes will continue to cop flack too. I must admit I am very pleased to see that the cookbook, Real Meal Revolution is completely sold-out in every major city. Much to the horror of many a registered dietitian no doubt, but the onus is on them to produce the evidence in support of their often outlandish claims that low-carb eating is “risky and dangerous” and “without any scientific basis”. Low-carb eating works for me and that’s all I know. I could never know if it would work for you or if it will be bad for you. But at least I’ll tell you I don’t know. Nutritional theory is a mine-field, but the more I research it, the more I agree with Gary Taubes. It is really just a system of personal beliefs and untested hypotheses, given a veneer of scientific respectability, when in actual fact it’s more like a religion – replete with irrational fanatics, money-making frauds and devout lemming-like followers. But each to their own I suppose, the thing that really gets my goat is this simple perpetuation of a culture in which bullsh*t trumps evidence and science loses.

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We are a small band of diabetics all low carbers. Posting links to diabetes related articles and low carb food advice. In our spare time we like to lampoon the spreaders of fear and misinformation. Welcome to the crazy world of diabetes.